Schizophrenia has three distinct phases, which share some overlapping symptoms. The three stages are prodromal, active, and residual. Diagnosing the stages of schizophrenia is important for an individual to receive the proper treatment to manage their condition.

Schizophrenia is a chronic mental illness that affects an estimated 24 million people worldwide.

This illness affects the way a person thinks, feels, and behaves. People with schizophrenia may experience:

People can manage their symptoms with the help of a care team that coordinates and delivers effective treatments. However, without treatment, symptoms of schizophrenia can severely impact a person’s ability to engage in work or school, live independently, and maintain healthy interpersonal relationships.

This article discusses the stages of schizophrenia, their causes, symptoms, diagnosis, treatment options, and where to seek emergency care.

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This is the first stage of schizophrenia. It occurs before noticeable psychotic symptoms appear. During this stage, a person undergoes behavioral and cognitive changes that can, in time, progress to psychosis.

The early stage of schizophrenia usually involves non-specific symptoms that also occur in other mental illnesses, such as depression.

Symptoms of prodromal schizophrenia include:

  • social isolation
  • lack of motivation
  • anxiety
  • irritability
  • difficulty concentrating
  • changes to one’s normal routine
  • sleep problems
  • neglecting personal hygiene
  • erratic behavior
  • mild or poorly formed hallucinations

According to the authors of one 2018 review, up to 73% of people with schizophrenia experience the prodromal stage before they develop the characteristic symptoms of schizophrenia.

Identifying individuals in the prodromal stage remains challenging.

In this stage, people with schizophrenia exhibit characteristic symptoms of psychosis, including hallucinations, delusions, and paranoia.

Active schizophrenia, or active psychosis, involves obvious symptoms such as:

  • hallucinations, including seeing, hearing, smelling, or feeling things that others do not
  • delusions, which are false notions or ideas that a person believes even when presented with evidence to the contrary
  • confused and disorganized thoughts
  • disordered or jumbled speech
  • excessive or useless movement
  • wandering
  • mumbling
  • laughing to oneself
  • apathy or numbing of emotions

The Diagnostic and Statistical Manual, Fifth Edition (DSM-5) no longer recognizes this stage for diagnosing purposes. However, it is still useful for describing the symptoms of schizophrenia.

In residual schizophrenia, a person experiences fewer or less severe symptoms than those seen in the active stage.

Typically, people in this stage do not experience positive symptoms, such as hallucinations or delusions.

The residual stage is similar to the prodromal stage. People may experience negative symptoms, such as a lack of motivation, low energy, or depressed mood.

Symptoms of residual schizophrenia include:

  • social withdrawal
  • difficulty concentrating
  • difficulty planning and participating in activities
  • reduced or absent facial expressions
  • flat, monotone voice
  • general disinterest

Schizophrenia is a multidimensional condition that arises from a number of variables. Research has shed light on the possible causes of schizophrenia. However, the reasons why people move through the phases of schizophrenia remain unclear.

A combination of environmental, genetic, and physiological factors may alter the brain’s structure and chemistry. These changes lead to schizophrenia.

Experts associate the following factors with schizophrenia:

  • Genetics: According to the National Alliance on Mental Illness (NAMI), people with a family history of schizophrenia are six times more likely to develop the condition.
  • Environment: A person’s environment can impact their risk for schizophrenia and other mental illnesses. The National Institute of Mental Health (NIMH) state that exposure to viruses, stress, and poverty may play a role in the development of schizophrenia. Lifestyle choices, trauma, and substance abuse may also have an impact.
  • Brain structure: Changes in brain structure and function can result in abnormal interactions between the brain’s neurotransmitters, such as dopamine. These changes may contribute to psychotic episodes and the progression of schizophrenia.
  • Substance use: Recent research suggests that substance use, especially during adolescence, can increase the risk of developing schizophrenia later in life. The authors of the NIMH article suggest that the genetic factors associated with schizophrenia may also contribute to the brain changes involved in addiction.

Doctors and mental health practitioners often diagnose schizophrenia during the active stage, when symptoms are most prominent.

A doctor must follow the criteria outlined in the DSM-5 to diagnose schizophrenia.

According to the DSM-5, a schizophrenia diagnosis consists of the following elements:

  • A person exhibits at least two of the following symptoms for a 1-month period:
    • delusions
    • hallucinations
    • disorganized speech
    • negative symptoms, such as reduced emotional expression or apathy
  • The symptoms reduce a person’s ability to function, affecting their professional or academic performance, interpersonal relations, or self-care.
  • Reduced functioning lasts for at least 6 months. During this 6-month period, a person exhibits symptoms for at least 1 month.
  • The active phase symptoms occur independently of major depressive or manic episodes.
  • Symptoms did not result from another medical condition, substance abuse, or medication.

While a person can develop schizophrenia at any age, the average age of onset varies slightly between men and women.

According to NAMI, the initial symptoms of schizophrenia usually appear between the late teens to early 20s for men and the late 20s to early 30s for women.

The authors of one 2018 case report state that schizophrenia can occur in children less than 13 years old, though this appears to be rare.

Although schizophrenia is a lifelong condition, it is treatable. Receiving timely and effective treatment can help manage symptoms and prevent relapses.

Treatment options include:

  • Antipsychotic drugs: These medications are available as daily oral doses or monthly injections. People who take antipsychotics as prescribed may experience less intense and less frequent psychotic symptoms. While effective, antipsychotic drugs can have adverse effects, such as weight gain and drowsiness.
  • Psychotherapy, such as:
    • Cognitive behavioral therapy: This form of treatment can help people develop useful coping skills and strategies for working through disruptive thoughts.
    • Psychodynamic therapy: Also known as psychoanalytic therapy, psychodynamic therapy involves conversations between a psychologist and their patient. These conversations attempt to uncover emotional experiences and unconscious processes that contribute to a person’s current mental state.
    • Acceptance and commitment therapy (ACT): ACT is a type of behavioral therapy that encourages people to accept, rather than challenge, their deep feelings. ACT also focuses on commitments to personal goals and values and improving one’s overall quality of life. Finally, ACT teaches mindfulness skills that can help keep a person focused on the present moment instead of being consumed by negative thoughts or experiences. Combining these three conditions, a person can change their behaviors by first changing their attitude towards themself.
    • Family therapy: This form of psychotherapy involves families and significant others of people with schizophrenia and other mental health conditions. It focuses on education, stress reduction, and emotional processing. It helps family members better communicate and resolve conflicts with one another.
  • Coordinated specialty care (CSC): CSC involves a team of health professionals that manage medication, deliver psychotherapy, and provide education and employment support.

If you or a loved one is experiencing suicidal thoughts or exhibiting dangerous or risky behaviors, please seek emergency care:

  • Dial 911 or visit the nearest emergency department
  • Call the NAMI HelpLine at 1-800-950-NAMI (6264)
  • Call the SAMHSA’s National Helpline at 1-800-622-HELP (4357)
  • Find a local extended observation unit (EOU) or crisis stabilization unit (CSU)

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

Schizophrenia is a complex, long-term condition that can significantly impact a person’s ability to function and maintain healthy relationships.

Effective treatments are available that can help a person manage their symptoms and prevent relapses.

People with schizophrenia also benefit from the support of their family and friends and access to community services.

Schizophrenia consists of three stages — prodromal, active, and residual.

The prodromal stage consists of non-specific symptoms, such as lack of motivation, social isolation, and difficulty concentrating.

Prodromal symptoms are not always obvious. As a result, diagnosing schizophrenia in this stage can be extremely difficult.

Active schizophrenia involves noticeable psychotic symptoms, such as hallucinations and delusions. People require immediate medical attention at this stage.

Timely diagnosis and prompt treatment can help reduce the severity and frequency of psychotic episodes.

The residual stage is no longer acknowledged as a diagnostic criterion, but it helps explain the progression of schizophrenia.

In the residual stage, hallucinations, delusions, and disorganized thinking are mild or completely absent. A person may continue experiencing symptoms from the prodromal stage.